Category: Uncategorized
Health care economist sentences to ponder
Various ideas to cut costs in Medicare and Medicaid have been proposed in recent years. Health economists generally oppose those changes.
And this:
If health economists were in charge of the health system, not a lot would change, with some notable exceptions. Medicaid would not have work requirements (which would be unpopular among conservatives in some states), and taxes would go up for Medicare and for employer-based health insurance (which would make it unpopular among just about everybody).
Here is a much longer and excellent piece by Austin Frakt, surveying what health economists in the United States believe about health care policy. Also do note that health care economists overwhelmingly tend to be Democrats.
What should we think about all this? That we can trust these health care economists to (more or less) endorse the current system because it is in fact pretty good, relative to available constraints? That radical reforms, as suggested by say some Democratic presidential candidates, are undesirable and unneeded? That the Democratic economists who endorse single payer are way overreaching? Or that these health economists are both deluded — in whichever direction — and also major wusses?
Inquiring minds wish to know. Here is a related Twitter thread from Michael Cannon.
*Just Hierarchy: Why Social Hierarchies Matter in China and the Rest of the World*
That is the new book by Daniel A. Bell and Wang Pei. It is perhaps not so novel to students of Jean Bodin and medieval political thought, or say Chinese history, but still the book crystallizes a moment and I consider its publication a matter of note. Here is one short bit:
But which hierarchical relations are justified and why? In our view, it depends on the nature of the social relations and the social context. As a method, we are inspired by Michael Walzer’s call for a pluralistic approach to justice. There is no one principle of justice appropriate for all times and places. Our main argument is that different hierarchical principles ought to govern different kinds of social relations. What justifies hierarchy among intimates is different from what justifies hierarchy among citizens; what justifies hierarchy among citizens is different from what justifies hierarchy among countries; what justifies hierarchy among countries is different from what justifies hierarchies between humand and animals, and…The sum total of our argument is that morally justified hierarchies can and should govern different spheres of our social lives…
The discussion of the Kama Sutra, and its notions of hierarchy, was interesting too.
Saturday assorted links
2. Phasing out squat toilets in Tokyo (a few years ago they were 40% of the total). And has Germany moved to a de facto UBI?
3. “‘Parasite’ Backers Gain $100 Million on Film Tackling Inequality.”
4. New Yorker covers Bryan Caplan on Open Borders.
5. Types of highway interchanges and their efficiency ratings.
6. Seeking to abolish the family? Crazy and and maybe evil too, but interesting.
Patients as Consumers in the Market for Medicine: Bedside Manner > Survival Probability
Young and Chen, 2020: Consumer-driven health care is often heralded as a new quality paradigm in medicine. However, patients-as-consumers face difficulties in judging the quality of their medical treatment. With a sample of 3,000 U.S. hospitals, we find that neither medical quality nor patient survival rates have much impact on patient satisfaction with their hospital. In contrast, patients are very sensitive to the “room and board” aspects of care that are highly visible. Quiet rooms have a larger impact on patient satisfaction than medical quality, and communication with nurses affects satisfaction far more than the hospital-level risk of dying. Hospitality experiences create a halo effect of patient goodwill, while medical excellence and patient safety do not. Moreover, when hospitals face greater competition from other hospitals, patient satisfaction is higher but medical quality is lower. Consumer-driven health care creates pressures for hospitals to be more like hotels. These findings lend broader insight into unintended consequences of marketization.
It doesn’t surprise me that consumers respond much more to nice nurses than to survival probabilities. Nice nurses are observable by patients but survival probabilities can only be estimated from sophisticated statistical models. I do wish that patients paid more attention to the outputs of sophisticated statistical models when choosing doctors and hospitals, as I think this would improve quality, but mostly they don’t. As a result, competition increases patient satisfaction but less clearly increases medical quality and medical excellence. The authors, in fact, argue that competition reduces medical quality but that part of their paper is weaker than the former and the bulk of the economic literature indicates that hospital competition also increases quality albeit not strongly and with some mixed results.
Hat tip: Kevin Lewis.
Does digital socialism have a future?
No, not a good future, according to Jesús Fernández-Villaverde:
Can artificial intelligence, in particular, machine learning algorithms, replace the idea of simple rules, such as first possession and voluntary exchange in free markets, as a foundation for public policy? This paper argues that the preponderance of the evidence sides with the interpretation that while artificial intelligence will help public policy along with several important aspects, simple rules will remain the fundamental guideline for the design of institutions and legal environments. “Digital socialism” might be a hipster thing to talk about in Williamsburg or Shoreditch, but is as much of a chimera as “analog socialism.”
The paper is an excellent response to a growing set of claims, I would add further material on the work of Michael Polanyi and the importance of inarticulable knowledge.
Friday assorted links
1. Martin Gurri watch, Scandinavian Airlines edition.
2. Profile of Zucman and Saez (NYT).
3. How the internet is changing chess (and by extension everything).
4. Dog surveillance.
5. De-convexifying the hotel checkout time (NYT). Small steps toward a much better world…
Very good sentences
Nearly all of the biggest challenges in America are, at some level, a housing problem. Rising home costs are a major driver of segregation, inequality, and racial and generational wealth gaps. You can’t talk about education or the shrinking middle class without talking about how much it costs to live near good schools and high-paying jobs. Transportation accounts for about a third of the nation’s carbon dioxide emissions, so there’s no serious plan for climate change that doesn’t begin with a conversation about how to alter the urban landscape so that people can live closer to work.
Those are from Conor Daugherty in the NYT, via the excellent Kevin Lewis.
A central bank digital currency is not a good idea, redux
The introduction of a central bank digital currency (CBDC) allows the central bank to engage in large-scale intermediation by competing with private financial intermediaries for deposits. Yet, since a central bank is not an investment expert, it cannot invest in long-term projects itself, but relies on investment banks to do so. We derive an equivalence result that shows that absent a banking panic, the set of allocations achieved with private financial intermediation will also be achieved with a CBDC. During a panic, however, we show that the rigidity of the central bank’s contract with the investment banks has the capacity to deter runs. Thus, the central bank is more stable than the commercial banking sector. Depositors internalize this feature ex-ante, and the central bank arises as a deposit monopolist, attracting all deposits away from the commercial banking sector. This monopoly might endangered maturity transformation.
Here is the NBER working paper by Jesús Fernández-Villaverde, Daniel Sanches, Linda Schilling, and Harald Uhlig. Here is my earlier Bloomberg column with similar themes.
The missionary roots of liberal democracy
I had not known of this important piece. From 2012, by Robert D. Woodberry, at the National University of Singapore:
This article demonstrates historically and statistically that conversionary Protestants (CPs) heavily influenced the rise and spread of stable democracy around the world. It argues that CPs were a crucial catalyst initiating the development and spread of religious liberty, mass education, mass printing, newspapers, voluntary organizations, and colonial reforms, thereby creating the conditions that made stable democracy more likely. Statistically, the historic prevalence of Protestant missionaries explains about half the variation in democracy in Africa, Asia, Latin America and Oceania and removes the impact of most variables that dominate current statistical research about democracy. The association between Protestant missions and democracy is consistent in different continents and subsamples, and it is robust to more than 50 controls and to instrumental variable analyses.
For the pointer I thank Ann Swidler.
Thursday assorted links
1. Toward a simple critique of applications and why most of them fail.
2. Additional results on migration and wages (The Economist).
4. The relentless bid? (from 2014)
Willingness to be Paid: Who Trains for Tech Jobs?
Here is a new paper from Joy Buchanan, Emergent Ventures winner:
Having a larger high-skill workforce is good for economic productivity, so it is useful to understand how workers self-select into high-paying technology jobs. This study examines how workers on the margin decide whether to pursue tech jobs, including a precise control for the opportunity cost of time. The most important determinant of the reservation wage for college students to do computer programming is whether they enjoy it or not. Another subjective influence, whether subjects like math or not, predicts self-confidence. Most students, including females and minorities, are willing to learn a new computer programming language, for a sufficiently high wage. Neither randomly assigned encouragement nor extra information on the programming task increases willingness to participate or increases confidence.
I often say that economics is too often solely the study of incentives, whereas real world problems end up solved because entrepreneurs opt for a potent mix of selection and incentives. Selection is often the more important part of that brew. Get people doing what they like, and you cannot boil a stone into a turnip. It is also noteworthy from the paper that a lot of people really do not seem to like programming.
In praise of art books
Running out of things to read? Do you ever have the sneaky feeling that books might be overrated? Well, for some variation at the margin try reading art books. That’s right, books about art. Not “how to draw,” but books about the content and history of art. Some of them you might call art history, but that term makes me a little nervous. Just go into a good art museum, and look at what they are stocking in their bookstore. Many of them will be picture books, rather than art history in the narrower, more scholarly sense of that word.
Art books offer the following advantages:
1. They are among the best ways to learn history, politics, and yes science too (advances in art often followed advances in science and technology). Even economic history. Since the main focus is the art, they will give you “straight talk” about the historical period in question, rather than trying to organize the narrative around some vague novelty that only the peer reviewers care about.
2. They are often very pretty to look at. You also feel you can read them in small bites, or you can read only a single chapter or section. The compulsion to finish is relatively weak, a good thing. You can feel you have consumed them without reading them at all, a true liberation, which in turns means you will read them as you wish to.
3. They have passed through different filters than most other books, precisely because they are often “sold into the market” on the basis of their visuals, or copyright permissions, or connection with a museum exhibit, or whatever. Thus they introduce variation into your reading life, compared to say traditional academic tomes or “trade books,” which increasingly are about gender, race, and DT in an ever-more homogenized fashion.
4. They are among the best ways of learning about the sociology of creativity and also “the small group theory” of history.
5. These books tend not to be politically contentious, or if they are it is in a superficial way that is easily brushed off. (Note there is a whole subgenre of art books, from theory-laden, left-wing presses, with weird covers, displayed in small, funky Manhattan or Brooklyn bookstores where you can’t believe they can make the rent, where politics is all they are about. Avoid those.)
6. A bookstore of art books is almost always excellent, no matter how small. It’s not about comprehensiveness, rather you can always find numerous books there of interest.
7. Major reviewing outlets either do not cover too many art books, or they review them poorly and inaccurately. That suggests your “marginal best book” in the art books category is really quite good, because you didn’t have an easy means to discover it.
8. You might even wish to learn about art.
9. This whole genre is not about assembling a reading list of “the best art books.” Go to a good public library, or museum bookstore, and start grabbing titles. The best museum bookstore I know of is at the Metropolitan Museum of Art in New York.
10. It is also a very good introduction to the histories and cultures of locations such as China and India, where “straight up” political histories numb you with a succession of names, periods, and dynasties, only barely embedded in contexts that make any sense to you.
Wednesday assorted links
1. Race in Stanford economics enrollment.
2. The political composition of journalists, as reflected by their Twitter feeds.
3. “I managed to walk to the North Pole, but I didn’t manage to walk to the airport from Boston.”
4. When did “Big Hair” peak? The data.
5. Florida school choice seems to have worked.
6. U.S. higher education has a foreign money problem (my Bloomberg column).
The bureaucratization of U.S. foreign policy
The NSC [National Security Council] was established in the 1947 National Security Act, which named the members of the council: president, vice president and secretaries of state and defense. The function of the council “shall be to advise the president with respect to the integration of domestic, foreign, and military policies relating to the national security.” The law required regular meetings…
Mr. Kissinger grew the council to include one deputy, 32 policy professionals and 60 administrators. By my count, alumni of his NSC include two secretaries of state, four national security advisers, a director of national intelligence, a secretary of the Navy, and numerous high-ranking officials in the State, Defense and Treasury departments as well as the Central Intelligence Agency.
But the NSC has only continued to expand. By the end of the Obama administration, 34 policy professionals supported by 60 administrators had exploded to three deputies, more than 400 policy professionals and 1,300 administrators.
The council lost the ability to make fast decisions informed by the best intelligence.
Here is more from John Lehman (WSJ).
Apply for Emergent Ventures
The application form is here, lists of previous cohorts of winners are here. And please note there are two special tranches:
Progress Studies tranche, and a tranche for:
“advancing humane solutions to those facing adversity – based on tolerance, universality, and cooperative processes”
And might anyone be interested in working on the issue of why production speeds for infrastructure and so many other projects have slowed down so much?
There has been a very impressive group of winners to date.